Key result
Early-onset anxiety predicts ~117% higher CHD risk in young men, but depression does not.
Why the study?
Most studies linking depression or anxiety with coronary heart disease examined older participants, leaving findings vulnerable to reverse causation from subclinical atherosclerosis.
Does early-onset depression or anxiety increase the risk of subsequent coronary heart disease in young men?
Cohort (n=49,321)
Yes
Does early-onset depression or anxiety increase the risk of subsequent coronary heart disease in young men?
Early-onset anxiety, but not depression, in young men is an independent predictor of subsequent coronary heart disease and acute myocardial infarction over a 37-year follow-up.
Early depression/anxiety may signal later CHD risk; extends prior data to younger ages but leaves causality and screening implications open.
OBJECTIVES: The purpose of this study was to investigate the long-term cardiac effects of depression and anxiety assessed at a young age, when reverse causation is not feasible. BACKGROUND: Most prospective studies found a relatively strong association between depression and subsequent coronary heart disease (CHD). However, almost exclusively, only middle-age or older participants were examined, and subclinical atherosclerosis might contribute to the observed association. The prospective association between anxiety and CHD was less evident in previous studies and has been subjected to similar methodological concerns on the possibility for a reverse causation. METHODS: In a nationwide survey, 49,321 young Swedish men, 18 to 20 years of age, were medically examined for military service in 1969 and 1970. All the conscripts were seen by a psychologist for a structured interview. Conscripts reporting or presenting any psychiatric symptoms were seen by psychiatrists. Depression and anxiety was diagnosed according to International Classification of Diseases-8th Revision (ICD-8). Data on well-established CHD risk factors and potential confounders were also collected (i.e., anthropometrics, diabetes, blood pressure, smoking, alcohol consumption, physical activity, socioeconomic position, family history of CHD, and geographic area). Participants were followed for CHD and for acute myocardial infarction for 37 years. RESULTS: Multiadjusted hazard ratios associated with depression were 1.04 (95% confidence interval [CI]: 0.70 to 1.54), 1.03 (95% CI: 0.65 to 1.65), for CHD and for acute myocardial infarction, respectively. The corresponding multiadjusted hazard ratios for anxiety were 2.17 (95% CI: 1.28 to 3.67) and 2.51 (95% CI: 1.38 to 4.55). CONCLUSIONS: In men, aged 18 to 20 years, anxiety as diagnosed by experts according to ICD-8 criteria independently predicted subsequent CHD events. In contrast, we found no support for such an effect concerning early-onset depression in men.
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Janszky et al. (2010) conducted a cohort in Coronary Heart Disease (n=49,321). Early-onset anxiety vs. No anxiety was evaluated on Coronary heart disease (CHD) (HR 2.17, 95% CI 1.28-3.67). Early-onset anxiety in young men independently predicted subsequent coronary heart disease events over 37 years (HR 2.17; 95% CI 1.28-3.67), whereas early-onset depression did not.
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